Endocarditis – Symptoms and Causes

Overview

Endocarditis is a serious condition where the inner lining of the heart’s chambers and valves becomes inflamed. This lining, known as the endocardium, can become damaged when harmful organisms enter the bloodstream.

The condition typically results from an infection. Bacteria, fungi, or other germs travel through the blood and attach to already damaged areas of the heart.

People with artificial heart valves, damaged heart valves, or other heart defects face higher risk.

The infection process begins when germs enter the bloodstream and make their way to the heart. Once there, these organisms attach to damaged heart tissue or valves, causing inflammation and further damage.

Symptoms

Endocarditis can develop either gradually or suddenly, with symptoms varying from person to person. The specific germs causing the infection and any existing heart conditions affect how symptoms appear.

Common symptoms include:

• Aching muscles and joints
• Pain in the chest during breathing
• Feeling extremely tired
• Fever and chills (similar to flu)
• Sweating at night
• Difficulty breathing
• Swelling in the legs, feet, or abdominal area
• New or changed heart murmur (whooshing sound)

Some less frequent symptoms may be:

• Weight loss without obvious cause
• Urine containing blood
• Tenderness beneath the left rib cage
• Painless red, purple, or brown flat spots on the palms or soles (Janeway lesions)
• Painful bumps or darkened skin patches on the tips of fingers or toe tips (Osler nodes)
• Small round spots (petechiae) that may appear on the skin, whites of the eyes, or inside the mouth

The severity and combination of symptoms can differ significantly between individuals.

When to See a Doctor

If you have signs of endocarditis, contact your healthcare provider right away. This is especially important if you have a heart defect present from birth or have had endocarditis before.

Many conditions can cause similar symptoms, so proper medical evaluation is essential for an accurate diagnosis.

Tell your doctor if you experience any of these symptoms after being diagnosed with endocarditis:

• Fever
• Chills
• Headaches
• Joint pain
• Shortness of breath

These symptoms may indicate that the infection is getting worse. Quick medical attention can help prevent complications and improve treatment outcomes.

Causes

Endocarditis typically develops from an infection. Bacteria, fungi, or other germs enter the bloodstream and make their way to the heart.

Once there, these microorganisms attach to damaged heart valves or injured heart tissue.

The human body’s immune system usually fights off harmful bacteria that enter the blood. However, certain conditions make infection more likely.

Bacteria normally found on the skin, in the mouth, throat, or intestines can sometimes enter the bloodstream and cause this serious heart infection.

When these microorganisms reach the heart, they find places to grow, especially on already damaged heart tissue, leading to endocarditis.

Heart Infection Risk Factors

The heart has four chambers that work together to pump blood. The top chambers (right and left atria) collect incoming blood, while the bottom chambers (right and left ventricles) pump blood out to the body and lungs.

Heart valves act as one-way doors between these chambers, keeping blood flowing in the correct direction.

People with certain heart conditions face higher risks of infection. When heart valves are damaged or artificial, bacteria can more easily attach to their surfaces. This creates an environment where infections can develop.

Several factors increase the risk of heart infection:

Age-Related Risks:

• People over 60 have a higher chance of developing infections

Heart Structure Issues:

• Artificial heart valves
• Damaged heart valves from conditions like rheumatic fever
• Birth defects affecting the heart
• Previous heart infections
• Implanted devices (pacemakers, defibrillators)

Health Behaviors and Conditions:

• Using injectable illegal drugs with unclean needles
• Poor dental hygiene and gum disease
• Long-term use of medical catheters

Some people may benefit from carrying a medical alert card that notes their risk for heart infection. This information helps healthcare providers take extra precautions during procedures that might allow bacteria to enter the bloodstream.

Possible Complications

Endocarditis can lead to several serious health problems. When bacteria and cell fragments gather in the heart, they form clumps called vegetations. These clumps may break away and travel to other parts of the body.

Common complications include:

• Heart failure occurs when the heart can’t pump blood effectively
• Damaged heart valves that don’t work properly
• Stroke from clots reaching the brain
• Abscesses (pockets of pus) in the heart or other organs
• Pulmonary embolism (blood clot in the lung)
• Kidney damage affecting filtering function
• Enlarged spleen due to infection response

Complications can arise when plant material breaks off and enters the bloodstream, affecting organs such as the brain, lungs, kidneys, and limbs.

Preventive Medicines

Some medical and dental procedures can let bacteria enter your blood. For people at high risk of endocarditis, doctors recommend taking antibiotics one hour before dental work.

You need these preventive antibiotics before dental procedures if you have:

• Previous endocarditis infection
• An artificial heart valve
• Certain heart transplant situations
• Specific types of heart defects present at birth
• Heart defect surgery within the last six months

Important steps for prevention:

1. Know the warning signs, such as a persistent fever, unusual tiredness, skin infections, or wounds that don’t heal.
2. Keep your teeth and gums healthy through regular brushing, flossing, and dental checkups.
3. Avoid illegal injection drugs. Unclean needles can introduce bacteria into your bloodstream.

If you have any heart condition, talk with your dentist and healthcare providers about your personal risk level. They can help decide if you need antibiotics before procedures.

Good dental health plays a key role in preventing heart infections. Regular brushing and flossing help control bacteria in the mouth that could otherwise enter the bloodstream through cuts in the gums.